NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance

被引:783
作者
Sylla, Patricia [2 ]
Rattner, David W. [2 ]
Delgado, Salvadora [1 ]
Lacy, Antonio M. [1 ]
机构
[1] Univ Barcelona, Dept Gastrointestinal Surg, Ctr Invest Biomed Esther Koplowitz, CIBERehd,IDIBAPS,Hosp Clin, E-08036 Barcelona, Spain
[2] Harvard Univ, Sch Med, Dept Surg, Massachusetts Gen Hosp, Boston, MA 02115 USA
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2010年 / 24卷 / 05期
关键词
Natural Orifice Translumenal Endoscopic Surgery; Transanal endoscopic microsurgery; Transanal; Rectal cancer; SURGERY NOTES; PORCINE MODEL; NOTES SURVIVAL; CHOLECYSTECTOMY; EXPERIENCE;
D O I
10.1007/s00464-010-0965-6
中图分类号
R61 [外科手术学];
学科分类号
摘要
The feasibility and safety of Natural Orifice Translumenal Endoscopic Surgery (NOTES) transanal endoscopic rectosigmoid resection using transanal endoscopic microsurgery (TEM) was previously demonstrated in human cadavers and a porcine survival model. We report the first clinical case of a NOTES transanal resection for rectal cancer using TEM and laparoscopic assistance, performed by a team of surgeons from Barcelona and Boston with extensive experience with NOTES and minimally invasive approaches to colorectal diseases. Transanal endoscopic rectal resection with total mesorectal excision using the TEM platform was performed in a 76-year-old woman with a T2N2 rectal cancer treated with preoperative chemoradiation. Laparoscopic visualization and assistance with retraction and exposure during rectosigmoid mobilization was provided through one 5-mm port, which was later used as the stoma site, and 2-mm needle ports, one of which was used as a drain site. The specimen was transected transanally followed by handsewn coloanal anastomosis. The procedure was completed successfully with an operative time of 4 hours and 30 minutes. Mesorectal excision was complete. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. The final pathology demonstrated pT1N0 with 23 negative lymph nodes and negative proximal, distal, and radial margins. NOTES transanal endoscopic rectosigmoid resection using TEM and laparoscopic assistance is feasible and safe. Careful patient selection and improvement in NOTES instrumentation are critical to optimize this approach before widespread clinical application.
引用
收藏
页码:1205 / 1210
页数:6
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